A St. Louis plastic surgeon introduces a game-changer in breast augmentation

Over the centuries, women have used ivory, glass balls, ground rubber, ox cartilage, Terylene wool, and polyester foam sponges to plump up their breasts. By the 1950s and ’60s, starlets were asking for silicone or paraffin injections—and winding up with breasts as hard as rock. Gel implants worked better…but ruptured and leaked. They’ve since been improved—and now there’s something that’s even more natural: the Ideal Implant.

Dr. Herluf Lund

OK, they named it strategically. But the Ideal Implant does have certain merits, gained by stabilizing the old, sloshy saline implants with silicone baffles. It was approved for use in both the U.S. and Canada in 2014 and released on the market in 2015. Now its creator, Dr. Robert Hamas, is expanding distribution, and he’s chosen Dr. Herluf Lund, president of St. Louis Cosmetic Surgery, to introduce the implant to the metro area. Other plastic surgeons will be trained to use these implants but must be personally approved by Hamas.

Intrigued but wary, we had a chat with Lund.

You’ve researched other breast implants yourself.

“Years ago, when I was a plastic surgery resident at Barnes, we were trying to develop an implant that would be radiolucent, so you could mammogram through it.” That implant didn’t work, but technology improved instead; today, when a woman with breast implants has a mammogram, there’s very little of the breast that’s not visible. “Then the silicone gel crisis hit, and I worked on the gel research. They brought out the cohesive gel implant, which people called the gummy-bear implant. It was a big step forward.

Why was the gummy-bear one so much better? “Before, all gel implants were free-floating, short chains of silicone molecules. This cross-linked the chains and gave the implant more stability,” so it wasn’t sloshing like a primitive waterbed. “If a woman has a very dense, tight breast, you can use a softer implant, but for an older woman who’s nursed children, you want an implant that acts a bit like an internal bra.”

Which carries more risk? They’re both safe, Lund says. (One study showed slight evidence of an increased risk of connective tissue disease, but he questions its methodology.) If a silicone implant breaks, the silicone no longer gets absorbed into the body. Today’s silicone has longer molecular chains that the body can’t absorb. The ruptured implant just sits there.

Why say saline offers greater peace of mind, then? Because saline does get reabsorbed, so within a week or so, the implant has deflated like a punctured tire. There’s no uncertainty, no chance of a “silent rupture” you won’t discover for years. And if a silicone implant has ruptured in place and you don’t find out for years, the wall that forms around it may thicken, or the shell may contract into a little ball that’s soon encased in scar tissue. In other words, removing a long-ago ruptured implant is trickier.

Do all implants rupture?

In seven-year studies, silicone and older-model saline implants have rupture rates ranging from 5.4 to 7.4 percent or higher. Ideal Implants have a rupture risk of 1.8 percent. Still, Lund says, “If someone tells you that an implant is going to last a lifetime, then you should search for a new physician.”

So why would anyone choose silicone?

Because in the past, it felt much more like a human breast, and the saline felt like, well, a water balloon. The Ideal Implant uses baffle walls of silicone between two chambers of saline, avoiding any sloshing and offering a more natural feel, better contouring, and less chance for the folding or wrinkling that can lead to rupture. In their resemblance to breast tissue, Lund says the early saline implants were a 1 on a scale of 1 to 10, and the Ideal Implant is maybe a 7.5.

Clinical data for the Ideal Implant do show some cases having complications or reoperation within three years of surgery, though.

Around 15 percent of women will return to the operating room in the first three years. Of those 15 percent, a significant number do so for a bigger implant. They start conservatively, worried that they’re going to wind up like Dolly Parton. Or the plastic surgeon says, ‘I know exactly what you need. Don’t you worry your pretty little head about it’—and the patient is not part of the decision. In my practice, less than 3 percent return to the OR for size reasons, and this is because the patient and I spend the time before the surgery to find the size she likes and the size that will work for her. Why some surgeons don't do this? It requires more time.

Why do most of your patients ask for implants?

“It’s almost always they are unhappy with their breast size. It doesn’t match their physique; their breasts are not in proportion to their hips. Or, women have nursed children and lost volume or begun to sag. Or they have significant asymmetry. Most women aren’t seeking some mythical cup size—there isn’t a standard cup size anyway! They’re seeking a balance and proportion with their body. The trick is, everyone’s sense of balance and proportion is different, and so is everyone’s definition of ‘natural.’”

Will we ever reach a point, societally, where women don’t feel the need to bother?

“Dr. David Sawyer at the University of Pennsylvania has spent his entire career going back through history, looking at various societies’ images of human beings. The symbol for the feminine is breasts. And in every one of these societies, they form an idealistic conception of what they ought to look like. Today, instead of hiding that they wear a padded bra, women are open about it.”

If this is wired in, why isn’t there more emphasis on male surgical enhancement?

“Ah. Well, there have been a lot of efforts put into trying to do that. It’s incredibly difficult. With women, you are putting a device into a stretchable organ with a fatty pocket. There is no fat in a penis. If you inject fat, which has been tried, the fat is not anchored, and it moves. Elongation doesn’t work, because you’re dealing with a tissue that’s designed to stretch and relax, not stay stretched. It’s vascular tissue, not glandular.”